Living with depression for over 13 years, Amy Marlow shares her seven coping strategies for when she feels an oncoming depressive episode.

A version of the following article first appeared on Life Effects Israel.

Amy Marlow lives with depression and generalized anxiety disorder. She is speaking on behalf of the National Alliance on Mental Illness (NAMI). She created this article for Life Effects Israel by adapting it from her blog.

I live with depression. Sometimes it's hard, sometimes it's easier, and sometimes I can't tell that I suffer from depression at all. But I have been diagnosed for over 13 years, so I know the warning signs and what comes afterward quite well.

Depression manifests in different ways for each person. For me, depression is like a deep and heavy sadness. It's like a thick fog that curls around me until everything else is out of sight. I can't find a way out, and my ability to see a positive future - or a tolerable present - becomes non-existent. 

But, over years of treatment, I've worked hard to understand how I feel during a depressive episode. I've now learned how to take care of myself when the fog descends.

7 ways I prepare myself for oncoming depressive episodes

1. I won't catastrophize

I'm very aware of the feelings that come before a bout of depression. So, when I feel the first hints of prolonged sadness and unshakeable fatigue, warning bells start ringing in my head: "No, not depression!"

It's devastating when I feel the onset of a depressive episode. There's trauma tied up with those feelings, and the thought of facing yet another battle makes me want to break down. 

I can have periods - long periods - of feeling good, and then my warning signs start to go off, and my mind turns to fear. I start obsessing over worst-case scenarios, my heart thudding in my chest. 

It's when this happens that I've reached the critical moment. This moment is when what happens next is a choice that's mostly in my hands. I could go off the deep end, or I could stop. Take a deep breath. Take ten more. 

I talk to myself aloud, reminding myself of all the times I've shown strength. I tell myself I'm allowed to feel anxious and afraid about what's coming. That's natural. But there has not been a single time when I haven't made it through. I've learned many things over the years, so whatever happens, I know I can handle what's to come. 

2. I’ve figured out my warning signs

I spent a long time figuring out how my thoughts and behaviors tend to change before I hit a downward spiral. Knowledge won't stop what's coming, but it helps me catch myself before I hit rock bottom. 

First up is catastrophic thinking. My usual thoughts turn to ones of self-pity and despair: "Nobody understands me. Everyone else has it easier in life. I'll never get over depression, and no one even cares. No matter how hard I try, I'll never be good enough." 

As soon as I catch myself thinking or saying anything like that, I know that another bout of depression is on its way. 

Another clue is how I manage myself. If my energy level is low for several days, and I struggle with daily tasks like cleaning, bathing, and cooking, that's a definite sign. Noticing these behaviors makes me stop and take pause. What may have triggered this old pattern to re-emerge? I talk things through with family and friends and make a new appointment with my therapist. 

It's tempting to ignore the warning signs and sink into fog when you're tired and feeling low. But if I let myself do that, the depression becomes much more challenging to deal with later on down the road. 

3. I remind myself that depression is an illness, not a character flaw

For a long time, I was convinced that my depression was a character flaw, not a disease. I would try to fix things "my way," which led to my symptoms becoming even more overwhelming. Sadness, guilt, and loneliness were all-consuming, while anxiety ensured that I'd never forget their presence. 

Reading available resources and speaking to healthcare professionals has helped me accept that depression is an illness. My depressive episodes get better through prescribed treatment and professional therapy, not by winging it and willing myself to be a "better person." 

My new perspective also had a surprising benefit: I'm not as afraid when symptoms reappear. They make more sense in the context of being a legitimate medical condition. I still feel sadness, fear, and loneliness, but I recognize these emotions as being symptoms of a medical condition. They're not irredeemable personal flaws. 

4. I understand these feelings won’t last forever

Despite every earlier episode proving differently, depression convinces me that my current low will never go away. That's why the warning signs are so scary. What if I'm trapped in the nightmare forever this time? 

One of the hardest parts of treatment is putting in the work to tolerate and manage depression when it next arises. In my case, a depressive episode has never just "gone away." I have to make a sustained effort. 

And, somewhat counter-intuitively, my ability to accept depression as a temporary burden has alleviated some of my suffering. I push on, even when it's verging on too difficult, knowing that this episode won't last forever. 

I've survived before, and I'll survive again. I'm allowed to feel angry and sad, but I won't let either of those emotions consume me. 

5. I practice self-care

I ignored and denied my symptoms of depression for a long time. I'd push myself when exhausted and pile more responsibilities onto my plate if I felt incompetent. 

Meanwhile, my everyday habits made my mental health worse. I'd smoke, drink, and shop whenever I wasn't buried in my work. Unsurprisingly, there came a day when I crashed entirely. Suffering from severe burnout, it took me two years to recover. 

That's why I now view taking care of myself as one of my highest priorities. I'd hit rock bottom and had to rebuild my life from scratch, taking pains to instill new, healthier coping mechanisms.

Part of my self-care is being honest about my diagnosis. I don't lie about my depression anymore. I respect myself and the life I've built. 

Self-care also means setting boundaries and saying no to others when overwhelmed. It means setting aside time to relax, exercise, eat proper meals, create, and connect with others. I use all my senses to soothe and recharge my body, mind, and spirit. 

Most importantly, I use these self-care skills as part of a daily regimen, not just at my worst. This dedication makes my coping strategies more effective when a depressive episode does come - I'm well-practiced at them! 

6. I know when to ask for help

Depression is a serious condition. For some people, like my father, depression can be deadly. Suicidal thoughts can be part of depression, and I don't ignore them when I have them. If I start to think of dying as a solution to my problems, I know that the warning signs have reached their peak. I reach out to someone I trust and turn to professional support immediately. 

I deserve help in treating my depression, and I know that I can't do it alone. In the past, I've used a Safety Plan, which listed the specific steps I should take in case of suicidal thoughts. Other warning signs suggesting I need professional help are: 

• Crying often 
• Isolating myself from friends and family 
• Lacking motivation at work and home 

I have a suicide prevention line saved to my phone, meaning I have someone to call at any time of the day or night. Although I may not act on my suicidal thoughts, it's still vital I get help as soon as they arise.

7. I don’t define myself by my depression

I'm not defined by my diagnosis or mental illness. I'm not depressed - I'm living with depression. I remind myself of this daily, especially when I'm in the fog. 

Depression can affect how we think, and it can make it difficult for us to appreciate who we are. Realizing that I'm not a "permanently depressed person" has put some control back into my hands. I have the strength, ability, and compassion to guide my way through depression when it strikes. I'm an expert in my own experiences. Developing awareness, acceptance, self-care, and both familial and professional support circles have changed my way of dealing with depression. 

To paraphrase one of my favorite internet memes: "I survived 100% of my worst days. As of right now, I'm doing great."

If you or a loved one wants to or has attempted suicide, call 911 or the emergency number for your country and stay with the person until help arrives.

If you or a loved one want to open up about thoughts of suicide, please see the resources below:

The 988 Suicide & Crisis Lifeline, https://988lifeline.org/, 988. The 988 Lifeline provides 24/7, free, and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.

Lifeline (US only): https://suicidepreventionlifeline.org/chat/, 1-800-273-TALK (8255). Lifeline also provides Spanish-speaking counselors and options for deaf and hard-of-hearing individuals. A 24-hour Online Chat is also available.

The Trevor Project (http://www.thetrevorproject.org/) is a 24-hour hotline for LGBT+ and questioning youth. 1-866-488-7386.

The information presented is solely for educational purposes, not as specific advice for the evaluation, management, or treatment of any condition.

The individual(s) who have written and created the content and whose images appear in this article have been paid by Teva Pharmaceuticals for their contributions. This content represents the opinions of the contributor and does not necessarily reflect those of Teva Pharmaceuticals. Similarly, Teva Pharmaceuticals does not review, control, influence, or endorse any content related to the contributor's websites or social media networks. This content is intended for informational and educational purposes and should not be considered medical advice or recommendations. Consult a qualified medical professional for diagnosis and before beginning or changing any treatment regimen.

NPS-ALL-NP-01278 JUNE 2024